Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition: Summary 11
The pressure should be moderate in order to reduce arterial blood flow, but not occlude the vessels. This is typically done by measuring the limb occlusion pressure (LOP) - the minimum pressure required to completely occlude blood flow to a limb. This is done using a doppler. Exercise pressures are then set as a percentage of LOP, typically: • 30-50% of LOP for upper body exercises • 60-80% of LOP for lower body exercises • Generally, higher pressures are used with lower resistance levels Tips for Taking LOP: • Have patients relax the muscle • Do not talk • Take in the same position in which the exercise will be performed (or least intense if in multiple positions) • A pulse ox can be used for the upper body but not the lower • This should not change much over an 8 week period of time, so there is no need to reassess every session unless there is swelling How to take LOP: • Place the cuff as proximal as possible. Find the pulse with the doppler, listening for 20 seconds. Inflate the tourniquet in 10-15 mmHg increments. Stop once the pulse cannot be located. Slowly deflate the cuff. When the pulse is heard again, this is the LOP: ○ For the upper extremity, use the radial artery
Aerobic exercise with BFRT is usually performed at low intensities, around 40% of VO2 max or 45% of the heart rate reserve. ACSM suggests using the heart rate to estimate the percent of VO2 max as follows: • 40% VO2 max = 55% HR max • 60% VO2 max= 70% HR max • 80% VO2 max= 85% HR max • 85% VO2 max= 90% HR max Proper Intensity of BFRT Resistance Training: • Use 3-4 sets of an exercise, starting with lower reps (10) and progressing to high reps (75) • Initially use longer rest periods (90 seconds) and progress to less rest (30 seconds) • Use a total session duration of 10-20 minutes • This can be used several times per week, up to 2 times per day • Progressions: ○ Start with passive BFRT for cell swelling ○ Progress to aerobic exercises/return to sport/HIIT with BFRT Key Points 1. Proper cuff placement: For lower body exercises, the cuff should be placed as high on the thigh as possible, close to the hip joint. 2. Monitoring patient response: Constantly check for signs of excessive fatigue, numbness, or tingling. 3. Gradual progression: Start with easier exercises and lower volumes, progressively increasing as the patient adapts. 4. Importance of form: Maintain proper form throughout the exercises, even as fatigue sets in. 5. Individualization: Adjust the protocol based on the patient's condition, pain levels, and response to the exercises 6. Education: Inform patients about the expected soreness and the difference between exercise-induced soreness and pain.
○ For the lower extremity, use the posterior tibial or dorsalis pedis
Resistance training with BFRT typically uses loads of 20-40% of one repetition maximum (1RM), much lower than traditional strength training.
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